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How will Infertility Care Be Affected by the Affordable Care Act?

February 27
,
2014
by: ASRM Office of Public Affairs
Published in ASRM Press Release

Highlights from Fertility and Sterility

It is clear that the Patient Protection and Affordable Care Act is going to have an impact on the 10% of American couples who experience infertility. It is not entirely clear, though, what the law’s ultimate effects will be.

In Fertility and Sterility, three reproductive endocrinologists with years of experience in academia, private practice and government research analyze ways the ACA will change the current landscape of insurance coverage and how different scenarios might result in patients gaining or losing insurance coverage for their infertility treatment.

The ACA’s requirement of “minimal essential coverage” may or may not result in more Americans with coverage for fertility care;

Existing state mandates for infertility coverage are threatened and new state mandates are discouraged under the ACA;

The ACA’s prohibition on denying coverage or charging higher premiums for “pre-existing” conditions may expand coverage;

The marketplace may incentivize insurers to include fertility treatments in their benefits packages;

And other ways costs and access to treatment may be affected.

Rebecca Sokol, MD, MPH, Acting President of the American Society for Reproductive Medicine (ASRM) observed, “The Affordable Care Act will improve access to healthcare for a large part of the US population. However, it is not yet clear how a substantial minority--the approximately 10% of Americans affected by infertility--is going to fare under the Act. Fortunately, the ACA has ended discrimination by insurance companies based on pre-existing conditions. Unfortunately, it still allows companies to discriminate against people suffering from the disease of infertility by not requiring coverage for their treatment. This article will bring attention to some of the ways in which the ACA may benefit our patients and the ways it may endanger their coverage for needed care. The authors alert us to possible ways to expand access to care in the future while showing us some new ways to view the changing playing field of insurance coverage. ”

The American Society for Reproductive Medicine, founded in 1944, is an organization of more than 8,000 physicians, researchers, nurses, technicians and other professionals dedicated to advancing knowledge and expertise in reproductive biology. Affiliated societies include the Society for Assisted Reproductive Technology, the Society for Male Reproduction and Urology, the Society for Reproductive Endocrinology and Infertility, the Society of Reproductive Surgeons and the Society of Reproductive Biologists and Technologists.

Editors’ Note: RESOLVE: The National Infertility Association is holding a free educational event in Washington, DC on February 27, 2014. The purpose of the event is to discuss exactly how the ACA impacts infertility medical care in the U.S. including its potential impact on the existing state insurance mandates for infertility, and specifically IVF coverage. Journalists are welcome to attend. Event Contact: Andy Schwarz 703.556.7172.